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Ask The Pharmacist: Help in case you’re losing your mind

Suzy Cohen
Columnist

Don’t you hate it when you’re introduced to someone and you can’t remember the person’s name? What about remembering whether you already told someone that story? It’s like one day you go from young to old.

This stuff seems to happen more and more as you age. Why does it happen to some of us, and not to others? I’ve wondered. I think it has to do with elevated homocysteine, at least in part. Emerging research about homocysteine connects it to neurofibrillary tangles, and those are associated with progressive memory disorders like Alzheimer’s. 

Image source: Getty Images.
Here's how James Lah, the lead researcher for the Alzheimer's Research Center at Emory, explains what's coming in Alzheimer's disease:

The baby boomers are now turning 65 at the rate of 10,000 a day. And one in nine of that 10,000 is going to have the disease. So while our phones are ringing off the hook now, it's nothing compared to what it's going to be like in the years to come.

When those phone calls come, doctors have little to offer. Of the five Alzheimer's drugs on the market -- including well-known Aricept from  Pfizer   (NYSE: PFE)  and Exelon from  Novartis   (NYSE: NVS)  -- none targets the underlying cause of the disease. In fact, 99.6% of all drugs designed to fight Alzheimer's have failed in trials since 2002.
But there is a colossal amount of research going into Alzheimer's at the moment, and progress is being made. Here's how a major shift in focus could lead to a whole new area of discovery.
Building on old failures to create new breakthroughs
Dean Hartley, the director of science initiatives at the Alzheimer's Association, explained how the tides are shifting this way: "We've started to realize that some of these treatments that have been used in clinical trials may actually be more effective if we use them earlier in the disease."
How much earlier? Said Hartley: "New data suggests that some of these proteins that are changing the brain may start anywhere between 15 and 20 years before the clinical onset."
The need to target the disease much earlier was the import of the latest breakthrough in Alzheimer's research. In a recent teleconference,  Biogen 's  (NASDAQ: BIIB)  chief medical officer, Alfred Sandrock, reported that the company's plague-busting antibody, called aducanumab, had been given to 165 patients, and in those who took the highest dose, it "practically eradicated" the amyloid plaques in their brains.
Sandrock then focused on how Biogen's drug could be used preventatively, much as "cholesterol-lowering statins are used to ward off heart attacks." He added: "The question will be, can you treat people even earlier? You could treat people before they have symptoms."
Despite aducanumab's apparent success, investor caution is in order. While Sandrock claimed there were some indications that the drug slowed cognitive and functional decline, the real test will come in larger studies. Those trials will include 2,700 participants and will take 18 months.
Exciting data, but a slippery problem
The risks and barriers for companies working in dementia are huge -- including the fact that our ignorance about this disease is still discouragingly high. In fact, scientists are split into two camps about what causes the disease in the first place.
Most companies go after the same disease target as aducanumab -- the sticky, cell-sized lumps of amyloid-beta that appear as plaques throughout the Alzheimer's-affected brain. But there's also evidence that Alzheimer's could stem from an unrelated pathology: the buildup of intracellular tau protein. If drugs like aducanumab are tackling the wrong cause, it would be like trying to mop up water on the floor from a roof leak while the rest of the house is falling down.
A flurry of programs aimed at earlier targets
If you follow Alzheimer's research, you've heard of  Eli Lilly 's  (NYSE: LLY)  wonder drug Solanezumab. In 2015, the drug was shown to tackle the underlying pathology of Alzheimer's, which put Solanezumab in a class of one. No drug had ever done that before.
Before that, Solanezumab failed late-stage clinical trials twice. But Lily never gave up on the drug. Trial data indicated it wasn't effective with late-stage patients, but it slowed cognitive decline in early stage patients by as much as 34%.
Regrouping and changing the endpoint to focus on earlier-stage disease, Lilly is trying again. Solanezumab's latest trial, called Expedition 3, is expected to wrap up in late 2016 or early 2017. Data should follow soon after. If the results are promising, that would put Lilly on track to be the first to approach the FDA for an approval.
While either Lilly or Biogen could well be the first to get a meaningful Alzheimer's drug on the market, the jury is still out on both their drugs.
A cure is a tall order, but a disease-modifying treatment could be coming relatively soon
Talk of a "cure" for Alzheimer's is perceived in scientific circles to be decades premature. But there is more optimism that we are approaching a treatment that could prevent or slow the disease. Alzheimer's in an incredibly tough puzzle to solve. But with several dozen drugs in trials, research is clearly progressing.
Putting numbers to it, drugs treating Alzheimer symptoms rake in over $6 billion a year. With over $170 billion being spent on Alzheimer's care in the U.S. alone, a drug that could modify or slow the devastating disease is estimated to generate at least $20 billion a year. With that kind of payoff, there's little chance drugmakers will give up.
Science works best when it works slowly. With so many gaping holes in our knowledge, we could still be on the wrong track. But there's plenty of reason for hope. So long as research continues, while Big Pharma and Big Biotech may lose the next round, we will eventually win the war.
Cheryl Swanson  has no position in any stocks mentioned. The Motley Fool owns shares of and recommends Biogen. Try any of our Foolish newsletter services  free for 30 days . We Fools may not all hold the same opinions, but we all believe that  considering a diverse range of insights  makes us better investors. The Motley Fool has a  disclosure policy .     The Motley Fool is a USA TODAY content partner offering financial news, analysis and commentary designed to help people take control of their financial lives. Its content is produced independently of USA TODAY.     Offer from the Motley Fool:   A secret billion-dollar stock opportunity

Did you know that NSAIDs and oral contraceptives are strong drug muggers of folate? If you deplete folate (vitamin B9), you block your methylation cycle, homocysteine builds up and memory becomes impaired. 

Perhaps maintaining brain function is related to declining levels of another B vitamin called “methylcobalamin.” It’s also known as vitamin B12, a nutrient that is manufactured by your intestinal flora.
Today, health food stores and online e-tailers offer various supplements that you can buy over-the-counter, but of course ask your doctor what’s right for you. I couldn’t possibly know what’s right for each of you and this article reaches million of people, so again, find out if these simple nutritional fixes are ideal for you.

ACETYL L-CARNITINE

The amino acid acetyl-l-carnitine crosses the blood-brain barrier more readily than regular plain L-Carnitine, and it helps the body make acetylcholine, the brain’s super neurotransmitter that is necessary for healthy mood and optimal cognitive function, as well as muscle health, a side benefit.

LION’S MANE

A 2014 study concluded that Lion’s Mane promotes the growth of nerve cells in the brain. Lion’s mane increases NGF (nerve growth factor), which then encourages the growth of new neurites. NGF encourages neurons to connect to each other, communicate better and simply put, this helps you learn faster and remember things better.

BACOPA MONNIERI

Bacopa monnieri exerts a strong protective effect on the brain because it inhibits the production of acetylcholinesterase, an enzyme that breaks down acetylcholine, and acetylcholine is a neurotransmitter that you want a lot of in your brain. 

GOTU KOLA

Gotu kola may help to increase the growth of neurons, promoting brain function, reducing mental fatigue, and supporting memory.

PHOSPHATIDYLSERINE

Phosphatidylserine begin to decline with age. It helps “connect the wires” upstairs and improve nerve impulse firing.

GREEN TEA

It’s found in green tea, and EGCG can cross the blood-brain barrier. A 2012 study in mice found that supplemental EGCG promotes brain plasticity in the hippocampus area of the brain.

Scan of brain

Today should be an important day for you, particularly if you’re now really thinking seriously about your memory for the first time. I’m not a fan of the “wait and see” approach when it comes to your brain. Our life experiences and family relationships as well as friendships are important memories. Your job depends on your ability to remember the simplest tasks. If you’d like to read the longer version of this article, just sign up for my newsletter at suzycohen.com and I’ll email it to you. 

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Suzy Cohen is a registered pharmacist. The information presented here is not intended to treat, cure or diagnose any condition. Visit SuzyCohen.com.